Clinical and pathological study on 47 cases of renal pelvic and ureteral tumors

47 cases including 24 renal pelvic tumors, 20 ureteral tumors and 3 renal pelvic and ureteral tumors treated in our hospital from January, 1980 to December, 1987, were studied clinico-histopathologically. The patients ranged in age from 38 to 81 years (average 65 years) the sex ratio was 3:1 with male predominance over female. Tumor occurred on the right side in 19 cases, on the left side in 27 cases and bilaterally in 1 case. The most frequent sign was hematuria which was observed in 40 cases (85%). The interval from the onset of initial symptoms to the first visit was within one month in 9 cases (19.1%). The major findings of excretory urograms were filling defect in 21 cases (47.1%) and non-visualizing kidney in 15 cases (33.8%). Positive urinary cytology was obtained in 21 cases (44.7%). Operative therapy as performed in 45 cases, namely, nephroureterectomy and partial cystectomy in 30 cases (66.7%) and nephroureterectomy in 9 cases (20%). Histopathologically, all cases but two cases of squamous cell carcinoma and to cases of mixed type carcinoma are transitional cell carcinoma. Subsequent bladder tumors were found in 8 cases (17.7%). The overall survival rate at 1, 3 and 5 years were 80.2%, 41.1% and 41.1%, respectively by Kaplan-Meier method. In this series, the interval from the onset of initial symptoms, the grade and stage of tumor and metastasis of lymph nodes were to be considered in developing prognosis.     

A clinical study on tumor of the renal pelvis and the ureter

The 39 cases of renal pelvic and ureteral tumors treated in our hospital from 1974 to 1983, were reviewed retrospectively. The 39 cases included 15 renal pelvic tumors, 21 ureter tumors and 3 ureteropelvic tumors. The incidence of these tumors was 0.15% among all new outpatients. Sex distribution was 25 males to 14 females, and mean age was 65.2 years old. Hematuria was the most frequent initial symptom and chief complaint. Of the patients, 28.6% had come to our hospital within one month after their initial symptoms appeared. "Filling defect", an important finding of IVP and RP, was revealed most frequently. The positive rate of urine cytology was 33.4%. Histological examination revealed 14 transitional cell carcinoma and 1 papilloma of 15 renal pelvic tumors and 19 transitional cell carcinoma, 1 polyp and 1 metastatic adenocarcinoma of 21 ureter tumors. Operative therapy was performed on 36 patients; 26 by nephroureterectomy with partial cystectomy. Vesical recurrence rate was 18.9%. The 5-year survival rate was 37.4% on renal pelvic tumor and 40.7% on ureter tumor. The factors, high grade, high stage, and ureteropelvic double tumor, which reflect the specificity of the malignant potential, also affected prognosis. In conclusion, post-operative adjuvant therapy was thought to be valuable in the near future.     

后腹腔镜下肾输尿管全长及膀胱袖状切除术35例报告

目的 介绍后腹腔镜下行肾、输尿管全长及膀胱袖状切除的体会。方法 经后腹腔镜施行肾输尿管全长及袖状膀胱切除术35例。男14例，女21例。年龄49～82岁，平均67岁。输尿管肿瘤20例，肾盂肿瘤15例。肿瘤位于右侧19例，左侧16例。其中输尿管肿瘤合并膀胱肿瘤者2例，先后发生双侧输尿管肿瘤并膀胱肿瘤者1例。经尿道用针状电极距输尿管口约0．5am环行切透膀胱。采用腰部3个穿刺套管针入路，行根治性肾切除，输尿管尽量向下游离，下腹部行5～9cm切口，取出肾标本，然后行下段输尿管及部分膀胱袖状切除。结果 35例手术顺利，手术时间1．5～6．0h，平均3．1h。出血量20～1600ml，平均166ml。4例需输血。术后20～32h下床活动。术后病理报告为移行细胞癌30例，输尿管低分化腺癌2例，输尿管鳞状细胞癌1例，输尿管平滑肌肉瘤1例，黄色肉芽肿性肾盂肾炎1例。1例术前为尿毒症透析患者，术后并发十二指肠漏，术后第3天放置引流管引流十二指肠漏出液，术后2个月死于心力衰竭。术后常规行膀胱灌注，预防肿瘤复发。平均住院时间11d。随访1～32个月，平均14个月，33例患者无瘤生存，1例术后3个月发生盆腔转移，目前带瘤存活。膀胱肿瘤均未见复发。结论 经后腹腔镜手术治疗肾盂和输尿管肿瘤，切口明显小于开放手术，术后恢复快。用电切镜环状切除输尿管末端可完整切除输尿管。     

A clinical study of tumor of the renal pelvis and ureter

We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.     

A clinical study on renal pelvic and ureteral tumors

Thirty-seven cases of renal pelvic and ureteral tumors treated at our hospitals between January, 1975 and December, 1985 were reviewed. There were 15 renal pelvic tumors, 19 primary ureteral tumors and 3 ureteropelvic tumors. There were 26 males and 11 females and their average age was 62.5 years old ranging from 37 to 82. The most frequent chief complaint was macroscopic hematuria, which was seen in 89% of the patients (33/37). It was 35% of the patients (13/37) who visited our hospitals more than one month but less than three months after the appearance of symptoms. The positive rate of urine cytology was 69%. Total nephroureterectomy was performed on 22 patients and the other surgical treatments were done on 13 patients. Histological examination revealed transitional cell carcinoma in all cases. The overall actual postoperative survival rate at 1, 3 and 5 years was 83.9%, 68.0% and 68.0%, respectively, as measured by the Kaplan-Meier's method. None of the patients who survived more than 3 years after surgery died. The actual 3 and 5 year survival rates in cases of ureteropelvic tumors were slightly lower than those in the case of bladder tumors. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy.     

A clinical study of the renal pelvis and ureteral cancer

During the 13 years from 1976 to 1988, 160 patients with renal pelvic and ureteral cancer were reviewed based on a new general rule for clinical and pathological studies on renal pelvic and ureteral cancer of Japanese Urological Association. There were 71 renal pelvic cancers, 80 ureteral cancers, and 9 cancers in both regions. Patients ranged in age from 35 to 91 years old (average: 63). The involved side was right in 63 and left in 97. The most frequent symptom was hematuria, which was seen in 81.1%. IVP revealed the findings of filling defects, hydronephrosis, and non-visualized kidney in 99.7% of the patients. Total nephroureterectomy with bladder cuff resection was performed in 123 cases, nephroureterectomy in 16 cases, nephrectomy in 5 cases, partial ureterectomy in 10 case, and biopsy in 6 cases. As adjuvant therapies, irradiation was performed in 32 and chemotherapy in 123. Histologically, 156 were with transitional cell carcinoma, one squamous cell carcinoma, one adenocarcinoma and 2 unclear, the over-all survival rate of this study at 1, 3, 5 and 10 years were 86.8%, 73.0%, 65.3% and 45.6%, respectively. No patient with lymph-node metastasis (N+) survived longer than 5 years. All patients with M(1) died within one year. There were no difference of prognosis between renal pelvic cancer and ureteral cancer. Regarding various prognostic factors, our series gave the same results as previous reports. However, it should be stressed that pathological grading was the most important prognostic factor.     

A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer

We reviewed 76 cases of renal pelvic and ureteral cancer, admitted to our hospital between January, 1975 and December, 1988, with special reference to the occurrence of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 35 of the 76 cases (46.1%), 7 with a preceding bladder cancer, 17 with a coexistent one and 11 with a subsequent one. In case of renal pelvic and upper ureteral cancer the incidence of coexistent or subsequent tumors of the bladder was 28.7% (16 of 56 patients). However, in the cases of lower ureteral cancer the incidence of these tumors was 82.4% (14 of 17 patients). This incidence was significantly higher than that in renal pelvic and upper ureteral cancer. The subsequent bladder cancer was observed in 19 patients including 8 patients who had a recurrence of the bladder cancer after the treatment for a preceding and coexistent bladder cancer. The cancer in most cases occurred within 2 years after the treatment of the upper urinary tract neoplasm. Of 19 patients who had subsequent bladder cancer 11 had primary sites in the renal pelvis and upper ureter. Another 8 patient had primary sites in the lower ureter. Four of the 8 subsequent bladder cancers in patients with lower ureteral cancer occurred just on and around the affected ureteral orifice. All these 4 tumors were high grade and high stage tumors. On the other hand, another 15 patients developed subsequent bladder cancer in a place other than the affected ureteral orifice. Of these 15 patients, 13 cases showed a low grade and low stage tumor.(ABSTRACT TRUNCATED AT 250 WORDS)     

原发性肾盂输尿管癌的诊断与治疗（附45例报告）

目的：提高肾盂输尿管癌的诊治水平。方法：回顾性分析我院自2000年1月～2008年3月收治的45例原发性肾盂输尿管癌患者的临床资料。结果：临床表现有血尿40例,腰痛8例,体检发现肾积水1例。阳性率较高的检查有逆行尿路造影、CT、MRI和输尿管镜检查,阳性率分别为66．7％（8／12）、78．8％（26／33）、90．0％（9／10）和90．0％（9／10）。35例（87．5％）做了肾输尿管全长切除、膀胱袖状切除术。35人（77．8％）得到随访,10例在术后13（5～33）个月内14次发生膀胱肿瘤,1例输尿管癌术后3．5年发现对侧肾盂癌,14例死于癌转移,5年总体生存率为34．3％（12／35）。结论：对反复出现的肉眼血尿、腰痛和肾积水患者要考虑本病的可能,联合应用几种检查方法是提高诊断率的关键,肾输尿管全切、膀胱袖状切除术是主要治疗方法。     

clinical studies on primary renal pelvic tumors

The 15 cases of the primary renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. The most frequent symptom was macrohematuria, which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.     

多层螺旋CT三维成像在肾盂输尿管癌诊断中的应用价值

目的探讨多层螺旋CT三维成像技术（3D-MSCT）在肾盂输尿管癌诊断中的应用价值。方法对73例上尿路肿瘤患者进行3D-MSCT检查，结果与手术病理结果进行比较。男53例，女20例。年龄48-78岁，平均63岁。其中肾盂癌44例，输尿管癌29例。结果3D-MSCT诊断肾盂癌44例，重建图像表现为肾盂或肾盏内软组织密度影，肾盂或肾盏腔内偏心性充盈缺损；输尿管癌28例，可疑输尿管占位病变1例，曲面重建（CPR）图像表现为输尿管管腔内软组织影，管腔内充盈缺损、管腔偏心狭窄或闭塞，上方输尿管不同程度扩张。肿瘤大小0．5cmx0．5cm～5．8cm×6．0cm。结论3D-MSCT可对肾盂输尿管癌进行直观立体观察，受肾功能影响小，是诊断肾盂输尿管癌有价值的方法。     

Clinical and pathological study of renal pelvic and ureteral tumors

This report is on 25 patients with primary urothelial tumor in the upper urinary tract who were admitted to our hospital from February, 1969 through January, 1983. The patients were 18 males and 7 females with a mean age of 66 years. The affected side was the right side in 11 cases, the left side in 12 and bilateral in 1 case (bilateral asynchronous ureteral tumor). The major symptoms were hematuria (69%) and flank pain (25%), with rare signs of fever. Total nephroureterectomy with bladder cuff was employed as the surgical method in 19 out of 25 cases. We performed conservative surgery in the case of non-infiltrating bilateral ureteral tumor. Pathologically, all 25 patients had transitional cell carcinoma. Over-all survival rate at 3 and 5 years was 64% and 51%, respectively. Our findings coincided with earlier reports by others that the prognosis of primary tumors in the upper urinary tract is related to the grade and stage of the tumor.     

A clinical survey of renal pelvic and ureteral tumors associated with bladder tumor

A clinical survey was performed on 80 cases of renal pelvic and ureteral transitional cell carcinomas we treated between January, 1963 and December, 1986. The cases included 30 of renal pelvic tumors, 17 of ureteral tumors, 3 of renal pelvic and ureteral tumors, 7 of renal pelvic and ureteral and bladder tumors, 16 of ureteral and bladder tumors and 7 of renal pelvic or ureteral tumors after treatment for bladder tumors. There were 37 cases of bladder tumors: 7 cases with preceding bladder tumors, 23 cases of synchronous bladder tumors, and 13 cases of subsequent bladder tumors. The 5-year survival for all cases was 60.2%. The 5-year survival for 43 cases unrelated with bladder tumors was 80.5% and that for 37 cases of bladder tumor was 41.6%. Therefore, there was a significant difference between these 2 groups (p less than 0.005). The 5-year survival for 50 cases without synchronous bladder tumors at first diagnosis was significantly higher than that for 23 cases with synchronous bladder tumors (p less than 0.001). Subsequent bladder tumors occurred after 2 to 48 months (mean 10 months) of the initial treatment for renal pelvic and ureteral tumors. Six of the 7 cases of preceeding bladder tumors were superficial tumors of pTa and pT1 and 3 cases had vesicoureteral reflux.     

A clinical survey on malignant tumors of upper urinary tract in a 10-year period

A clinical survey was done on 107 patients with malignant tumor of the upper urinary tract (50 renal tumors, 25 renal pelvic tumors, 32 ureteral tumors) treated at our Department during the last 10 years (1976-1985). All types of tumors occurred more frequently in males than in females. The age groups of patients in which renal, renal pelvic and ureteral tumors were seen most frequently were those in their sixties, sixties and seventies, respectively. The most frequent primary symptom in patients with these three tumors was gross hematuria. The 5-year actual survival rate for the patients with renal, renal pelvic and ureteral tumors was 48.1, 37.9 and 31.8%, respectively. For all 3 kinds of tumors, the prognosis of patients with high-grade and high-stage cancer was worse than that of patients with low-grade and low-stage cancer. One-hour erythrocyte sedimentation rate for all the tumor types, weight of resected kidney in the case of renal tumor, and the class of urinary cytology and drip infusion pyelography findings in the case of renal pelvic and ureteral tumors were considered to be the factors possible influencing prognosis.     

Recurrence and prognosis of renal pelvic and ureteral carcinoma

Eighty-three patients with renal pelvic and ureteral carcinoma operated in Chiba University Hospital were followed. Age ranged between 23 and 79 years old (average 61.8 years) with the male-to-female ratio of approximately 2:1. Localization of tumors was in renal pelvis in 41 (49.4%), ureter in 29 (34.9%) and both in 13 (15.7%). Significant correlation in prognosis was obtained with macroscopic hematuria, histological classification, grade, stage and regional lymph node involvement. Recurrence was found on 49 cases (59%), 21 had intra-vesical tumor and 28 showed retroperitoneal recurrence or distant metastasis. In the former the mean tumor free interval was 14.8 months and 5 year survival rate was 62.1%. In the later the mean tumor free interval was 6.5 months and 3 year survival rate was 5%. 8 (38.1%) in 21 cases with low stage papillary transitional cell carcinoma showed recurrence and it was all intra-vesical tumor. 25 (56.8%) in 44 cases with high stage papillary transitional cell carcinoma showed recurrence. Retroperitoneal recurrence or distant metastasis was recognized in 12 cases. On the other hand 14 (87.5%) in 16 cases with non-papillary transitional cell carcinoma showed recurrence, which was all retroperitoneal recurrence or distant metastasis.     

Regional lymphadenectomy for renal pelvic and ureteral cancers

Thirty-four patients with renal pelvic and ureteral cancers received regional lymphadenectomy since 1980. The patients consisted of 21 with renal pelvic cancers, 10 with ureteral and 3 with renal pelvic and ipsilateral ureteral. Fifteen patients (44.1%) had metastatic nodes: 13 with renal hilar or para-aortic metastases and 2 with pelvic nodal involvements only. Thirteen of these 15 patients with nodal metastasis had high grade tumors and 14 had high stage tumors. The 5-year survival rate of these 15 patients was 26.3% which was considerably poor when compared with 19 patients without metastasis. Twenty patients with high grade and high stage tumors who received respective operations with regional lymphadenectomy had significantly better prognosis compared with the historical control group (15 patients, from 1961 to 1979). Additional regional lymphadenectomy for renal pelvic and ureteral cancers appears to be a valuable operation for improving prognosis.     

Clinical observation on renal pelvic and ureteral tumors

During the 18 years from October, 1971 to September, 1989, 40 patients with renal pelvic and ureteral tumors were treated at our Department of Urology. Thirty were male and 10 female, and were between 44 and 83 years old with a mean age of 65.5 years. Histopathologically, there were 38 transitional cell carcinomas and 2 squamous cell carcinomas. There was a positive correlation between grade and stage of tumor. Among the patients with transitional cell carcinoma, the five-year survival rate was 54.4% for all the patients, 57.1% for patients with renal pelvic tumors and 48.4% for those with ureteral tumors respectively, as measured by the Kaplan-Meier's method. Stage and intravascular invasion of the tumor were the most influential factors for prognosis. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy, such as bladder instillation or peroral administration of various anti-tumor drugs, as a prophylactic use for recurrence of the bladder tumor in low stage cases.     

A clinical study on 34 cases of urothelial cancer of upper urinary tract

Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.     

A clinical investigation on renal pelvic and ureteral tumors

The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.     

Clinical study of urothelial tumors of the upper urinary tract. 2: Primary ureteral tumors

Twenty-five primary ureteral tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 18 males and 7 females (2.6: 1), and average age was 63.04 years old. The major symptom was hematuria. The majority of the patients were admitted to our clinic within 6 months from manifestation of symptoms. The major finding of IVP was non-functioning kidney. The positive rate of urinary cytology was 63.2%. Total nephroureterectomy with bladder cuff was performed in 21 out of 23 cases. Histologically, 22 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumor was found in 13 cases in the bladder. Most of the ureteral tumors (63.6%) were found in the lower third segment of the ureter. Subsequent urothelial tumors were seen in 3 bladders and one urethra out of 22 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by actuarial method was 39.4%. Among several factors, grade and stage of tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.     

经尿道电气化切除下段输尿管在上尿路肿瘤治疗中的应用

目的探讨经尿道电气化切除下段输尿管在上尿路肿瘤治疗中的应用价值。方法采用肾切除 经尿道电气化切除下段输尿管治疗上尿路移行细胞癌26例。结果26例手术时间1．5～2．5h，平均2h，腹膜后引流管留置24～48h，导尿管留置3～5d．术后未见出血、尿瘘、感染及切口肿瘤种植等。22例获得随访4～74个月．平均38个月，3例手术后6～9个月发生膀胱移行细胞癌并行膀胱部分切除或TUR—Bt术，患侧输尿管走行区及输尿管膀胱开口部未见肿瘤复发。结论该手术方法创伤小，术后并发症少．效果良好．是治疗上尿路肿瘤的有效手术方法。